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HEY, JOE
Philippines sits on HIV
time bomb
By Ted Lerner
MANILA - It would probably be a fair assessment
to say that a sizable majority of Filipinos in this
mainly Catholic nation believe in miracles. But even the
most pious of believers might have a difficult time
swallowing one particular miracle being peddled these
days.
According to the Department of Health
(DOH), the number of Filipinos who had, as of 2002,
contracted the human immunodeficiency virus (HIV) stood
at a mere 1,503. Now compare that to the numbers which,
according to figures from the Joint United Nations
Program on HIV/AIDS (UNAIDS), showed 7.1 million people
in the Asia-Pacific region with HIV at the end of 2001
out of a total 40 million people worldwide. An estimated
1.07 million people in the Asia-Pacific region got
infected in 2001 alone, with close to half a million
deaths due to AIDS, the disease HIV causes, in the same
year.
Yet the Philippines only reported a grand
total of 1,503 cases of HIV, which is one of the lowest
infection rates in the world. This in a country that has
one of the lowest rates of condom usage in Asia. This in
a country that has anywhere from half a million to 2
million sex workers, a good majority of whom don't
require their customers to wear condoms. This in a
nation that has more than 7 million overseas workers,
separated from spouses and often engaging in risky
sexual behavior. This in a country that, as of the
moment, has practically no awareness program to teach
the exploding population of young people about the
dangers of HIV/AIDS.
Did the HIV/AIDS epidemic
pass the Philippines by, as many in government would
like to believe? Is this another astonishing miracle in
this highly religious country? What does the Philippines
know that other countries don't, seeing that it has
seemingly avoided the HIV/AIDS epidemic?
These
are the questions which form the premise of a
frightening new book from Australian author and longtime
Philippine resident Earl Wilkinson, AIDS Failure
Philippines? (2003, Book of Dreams). Right from the
book's ominous cover, it becomes clear the answers to
these questions are not what government officials would
want to hear.
Chapter by chapter Wilkinson
systematically lays bare the bitter truth behind the
incredibly low HIV/AIDS figures being dispense by the
Philippine government. The 75-years-young author, who
has been a crusader for social issues in the Philippines
for many years, writes that, "in the investigations, the
more questions that were posed, the thicker the blanket
of silence came down". But through meticulous research
he manages to show that while the government proudly
proclaims that the HIV/AIDS epidemic has passed the
Philippines by, the scope of the problem is, in fact,
much larger than anyone knows. In fact, Wilkinson points
out, the Philippines couldn't possibly have such a low
HIV/AIDS rate as all the ingredients of an epidemic
clearly exist in the country. Instead, he insists, the
Philippines is sitting on a social time bomb fueled by
utter complacency and denial on the part of the
government. And if something isn't done to tackle the
problem soon, he says, an entire generation of Filipinos
may be unnecessarily decimated.
The operative
phrase used by officials here to describe the scope of
HIV/AIDS in the country is "low and slow". Some have
claimed that this is because AIDS is a foreign
affliction, or that because Filipinos are fond of
praying. Even President Gloria Macapagal-Arroyo stated
before a major AIDS conference in Manila that the reason
for the low AIDS rate in the country was that Filipinos
have "high morality". The Department of Health doesn't
go that far, but it does offer several official reasons
HIV/AIDS in the Philippines is "low and slow".
Among them are that female sex workers have
fewer sexual partners than their counterparts in other
countries; Filipino men do not frequent sex workers as
much as men in other countries, because, they say, of
moral-ethical pressures and lack of income; anal sex is
not common in the Philippines; there are fewer injecting
drugs in the Philippines; Filipinos tend to start having
sex at a later age than people elsewhere.
Wilkinson points out, however, that while some
of the reasons may, if taken at face value, be true, one
only has to dig a little deeper to see that the DOH has
its head firmly stuck in the sand. Yes, the sex workers
may not have as many customers as, say, those in
Thailand. But a more revealing fact is that a good
percentage of Filipino sex workers do not require their
customers to wear condoms. The claim that Filipino men
don't frequent sex workers as much as men in other
countries because of moral-ethical pressures and lack of
income is also easily shot down. In almost any city,
town or village in the Philippines, cheap sex can be
easily found in beer gardens and nightclubs. On the
claim that Filipinos become sexually active at a later
age than people elsewhere, one non-governmental
organization (NGO) study revealed that among males, the
starting age is between 12 and 14, while for women the
starting age is between 15 and 18.
Wilkinson
spends several chapters discussing condom use, or the
lack of it, and the controversies this humble rubber
sheath has caused in the Philippines. It is an accepted
fact internationally that condoms work in helping to
stop the spread of sexually transmitted diseases (STIs)
including AIDS. The Catholic Church, however, sees the
condom as a contraceptive device and thus bans its flock
from using them. In the Philippines the Catholic Church
has always held great power and their influence has led
to disastrous results for awareness campaigns.
In the early 1990s the government of president
Fidel Ramos, a Protestant by religion, made some strides
in family planning and AIDS awareness. Ramos knew that
to advance economically, the Philippines had to slow
down its population growth, which at 2.3 percent
annually is one of the highest in Asia. At the time
HIV/AIDS was also becoming a looming problem. Ramos'
health secretary, Dr Juan Flavier, realized that the
Church strictly disapproved of the promotion of any
contraceptives, especially condoms, and promoting them
could result in a backlash. But with AIDS becoming an
obvious threat, Flavier saw an opening. He started a
nationwide, high-profile campaign promoting the use of
condoms as a way to slow population growth and to help
stop the spread of HIV/AIDS.
The public at large
seemed to like the campaign and responded favorably. The
Catholic Church was incensed, however. Promoting
condoms, as well as sex education, they said, promotes
promiscuity. They lambasted Flavier in the press and
from the pulpit.
Wilkinson documents how,
despite international scientific acceptance of the fact
that the use of condoms is the best deterrent against
contracting HIV - save for abstinence - the Catholic
Church in the Philippines embarked on a massive and
aggressive disinformation campaign designed to condemn
condoms, making outrageous claims that they are in fact
dangerous. Through the church pulpit, led by the
Archbishop of Manila, Jaime Cardinal Sin, letters sent
to the editor of major newspapers and pro-church NGOs,
the Church proclaimed that the microscopic pores in the
latex of condoms were not small enough to prevent the
AIDS virus from passing through. One group, Pro-Life
Philippines, actually altered a Johns Hopkins University
report on condoms - which stated that condoms do indeed
work - then distributed the information in its own
pamphlets, saying the report states that condoms leak
the virus.
The Church and its backers took their
argument even further, saying publicly that promoting
contraceptive devices actually helps spread HIV. One
priest's writing in a local paper actually made the
claim that the DOH was in effect responsible for the
rising number of AIDS cases in the Philippines. This
despite the fact that the figures make clear that the
use of condoms decreases the spread of sexually
transmitted diseases. In Thailand the "100 Percent
Condom" program has been one of the world's most
successful. Condom usage for sex workers went from 25
percent of all sex acts to 90 percent. Naturally STI
rates in Thailand declined by 80 percent.
Unfortunately the campaign against condoms in
the Philippines has worked, with condom usage falling
dramatically in recent years. One recent study said that
only 1.7 percent of sexually active men use condoms. In
the southern seaport city of Davao, condom use by sex
workers went from 36 percent six years ago to only 9
percent in 2002. Of 300 sex workers polled there, 273
said they have unprotected sex with customers at least
two times a week. Concurrently STIs have been rising
dramatically in Davao, so it must stand to reason that
so too has HIV. Amazingly, though, between 1998 and 2002
not one case of HIV has been reported in Davao.
Under President Arroyo, a staunch Catholic who
toes the Church line on nearly every issue, STI and
HIV/AIDS awareness campaigns have practically
disappeared. The very department of the government
tasked to do all it can to contain an HIV/AIDS epidemic
is refusing to promote the use of condoms. Provisions
for contraceptive supply procurement were incorporated
into the Department of Health budget for 2002. However,
fundamentalist Catholic groups, who have played a big
part in Arroyo's government, succeeded in derailing the
purchase. Apparently the DOH had to get the agreement of
the Church for the purchase and, thus, the US$12 million
acquisition was aborted. The 2001 budget of $14 million
for contraceptive supply procurement was not even used.
The complete lack of educational and awareness
campaigns informing the public, especially the large
numbers of youth, of the dangers of contracting HIV/AIDS
is surely leading to disastrous consequences. In one
survey men aged between 15 and 45 were asked what they
thought would protect them from HIV. The three most
popular answers: taking antibiotics, keeping fit and
healthy, and saying a prayer. Which makes Wilkinson
wonder: While other countries have been initiating
HIV/AIDS education programs and promoting condom use,
the Philippines has been going the other way, leading to
a sharp decline in the use of condoms. Combine this with
the fact that tens of thousands of overseas workers,
many of whom admittedly engage in risky sexual behavior,
return to the country every year. All of this would make
the Philippines ripe for an epidemic, wouldn't it? Just
how is it that the numbers of HIV infected in the
Philippines are some of the lowest in the world?
One clue comes in the fact that few high-risk
people ever get tested for HIV/AIDS. Sex workers in the
honky-tonk town of Angeles City are tested weekly for
sexually transmitted diseases, but they are not required
to take an AIDS test. In fact it's illegal in the
Philippines to force somebody to take an AIDS test.
Naturally nobody, especially a bar girl, is going to
volunteer to have an AIDS test done, as a positive
result could be the end of her livelihood. Anyway, the
sex trade is technically illegal in the Philippines so
there's no way for the government to control it.
Another factor in the underreporting of HIV/AIDS
cases comes from the many doctors in the provinces who,
through sheer ignorance, may treat a particular disease
without knowing the patient has HIV. Victims are said
not to die of AIDS. Instead they die of tuberculosis,
meningitis, pneumonia, etc. Another factor is the
tremendous social stigma that comes with being
HIV-positive in the Philippines. Thus some doctors,
often at the pleading of their patients, do not report
an HIV-positive test to the Department of Health.
Thus, the DOH figures are clearly way off base.
Conservative estimates are that 10 times the stated
number have HIV. Flavier, who is now a senator, believes
it's 100 times the official figure. So, by various
estimates, between 15,000 and 150,000 Filipinos are out
there with the AIDS virus. And statistics indicate that
a majority of them are sexually active and will not wear
condoms.
Could HIV/AIDS in the Philippines
really be "low and slow", especially seeing as all the
ingredients for an epidemic are so glaringly obvious?
Other countries also believed they were "low and slow"
before seeing a sharp rise in infections, such as
Vietnam and Indonesia. But, in fact, the virus may have
already spread beyond "low and slow" in the Philippines.
Wilkinson points out that STIs have been continually
rising in the country for several years, and people with
STIs are more likely to contract HIV than those without.
Tuberculosis has been on the rise as well, which in the
Philippines which might mean that AIDS is on the rise
too.
Wilkinson claims that through its
complacency and outright denial of the problem, the
Philippine government, along with the Church, is dooming
tens of thousands of Filipinos, if not more, to die
horrible deaths because of AIDS. Unless, of course,
there is a veritable miracle happening throughout the
country. But while the Philippines might be a country
where many miracles do occur, continuing to believe in
this one is obviously going to prove terribly costly.
"There is no room for complacency," said Dr
Nafis Sadik, the UN secretary general's special envoy
for HIV/AIDS in Asia, who is quoted in Wilkinson's book.
There is a "huge explosion potential" for HIV/AIDS in
the Philippines because "all known routes of
transmission have been observed here".
(AIDS
Failure Philippines? is published by Book of Dreams,
Verlag, Germany. For more information please visit
http://www.book-of-dreams.com/.)
Ted Lerner is the author of
the book Hey, Joe - A Slice of the City, an American
in Manila, as well as an upcoming book of Asian
travel stories, The Traveler and the Gate Checkers.
E-mail ted@hey-joe.net or visit www.hey-joe.net.
(©2003 Asia Times Online Co, Ltd. All
rights reserved. Please contact content@atimes.com for
information on our sales and syndication policies.)
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